Minor Ills Are Major In Nursing Home

When elderly or infirm patients move into nursing homes, they expect close access to quality medical care. But quite often they also find themselves close to people much sicker than they are.

The result is that many healthy but frail people get sick after they take up residence in a nursing home.

Infection is the major cause of hospitalization among the nation`s 1.1 million nursing home residents, and medical authorities say it`s at least partly because the facilities aren`t keeping up with infection-control procedures practiced in the nation`s hospitals.

``We`ve known for awhile that nursing homes are lagging behind more acute hospital care in this regard,`` said Dr. Bruce Dan, a senior editor of the Journal of the American Medical Association. ``But it`s not a crisis at all, and in fact the procedures which need to be implemented are really very simple.``

Dan, an infectious disease specialist, said the problem is difficult to avoid given the population involved.

``People who are in nursing homes are usually elderly and are in those homes usually because they have some infirmity,`` he said. ``That`s going to cause more infections.``

Approximately 1.5 million infections are recorded annually in nursing homes, an average of more than one per person, but Dan said many people get more than one and others get none.

Three of the most common kinds of infections recorded in nursing homes are urinary and skin infections and minor diseases such as influenza.

In the first extensive study of the problem, Dr. Kent B. Crossley and his colleagues at the University of Minnesota Medical Center in Minneapolis surveyed 378 state nursing homes recently to determine their infection control procedures.

They found safeguards were not as stringent as they should be, with resulting infections accounting for 27 percent of nursing home admissions to hospitals. However, they concluded remedies could be implemented easily.

``This is simple low-tech stuff,`` Crossley said. ``It`s education of employees, telling them to wash hands between taking care of patients, and it`s not very expensive at all.``

One problem the researchers noted was that many nursing homes did not regularly monitor their residents to see if they were developing an infection. On the positive side, the study found that 85 percent of the nursing homes surveyed followed state regulations with respect to infections. More enforcement is needed, however, and new policies are needed in some states, Dan said.

While more stringent infection control practices may increase the cost of nursing home care, Dan said any improvement would be cost-effective.

``If you can prevent (patients) from getting infections in the nursing homes, you can save the public a great deal of money,`` Dan said. ``For one dollar of attention beforehand, you can save $1,000 in medical care.``